The purpose of this topic is to increase clinician knowledge of the dynamic gait index and the miniBest Test, especially in as it pertains to the geriatric population.
The clinician will understand the test measures and which tools are appropriate to assess the patient
The clinician will learn the benefits and/or downfalls of both balance tests
The clinician will be able to identify which patients are most appropriate for both of the balance test.
The clinician will learn about the evidence related to both of the balance assessments
Dynamic Gait Index Purpose (DGI): Assesses the patient’s ability to modify balance while walking in the presence of external demands. Dynamic Gait Index: Measures vestibular balance, non-vestibular balance, functional mobility and gait. It is performed with a marked distance of 20 feet and can be performed with or without an assistive device. The test requires a shoe box, two obstacles of the same size, stairs and a 20 foot pathway. DGI Scoring: Scores are based on a 4- point scale. A score of 3 on a task indicatesno gait dysfunction, 2 indicates minimal impairment, 1 indicates moderate impairment and 0 indicated severe impairment. The highest score possible is 24 points. < 19 indicative of increased fall risks (Sensitivity 59%, Specificity 64%)/(Sensitivity 67%, specificity 86%) In community dwelling older adults (4, 5) DGI Task: Steady state walking, walking with changing speeds, walking with head turns both horizontally and vertically, walking while stepping over and around obstacles, pivoting while walking, and stair climbing. (1,7) Pros and cons
Takes less than 10 minutes to administer
Excellent inter/intra-rater reliability in elderly adults in the hospital and outpatient setting
Hospital:
intrarater reliability (ICC = 0.90)
interrater reliability (ICC = 0.92)
Outpatient Rehabilitation:
intrarater reliability (ICC = 0.89)
interrater reliability (ICC = 0.82) (1,7)
No Floor effect in generally healthy older adults
Poor ceiling effect, 40% of healthy adults reach maximum score at baseline; 70% at maximum score after intervention. (3)
There are adequate ceiling effects for multiple sclerosis and stroke patients and minimal floor effects for stroke patients. (1,7)
The Mini Best Test Purpose: Shortened version of the Balance Evaluation Systems Test (BESTest), a clinical balance assessment tool that aims to target and identify 6 different balance control systems. The Mini Best Test: Measures 4 dimensions of balance including; anticipatory postural adjustments, reactive postural control, sensory orientation and dynamic gait. It allows the clinician to prepare treatments specific to the patients identified deficits. In order to perform this test the following is needed: Temper® foam (also called T-foamTM 4 inches thick, medium density T41 firmness rating), chair without arm rests or wheels, incline ramp, stopwatch, a box (9” height) and a 3 meter distance measured out and marked on the floor with tape [from chair]. Mini Best Test Task: Sit to stand, rise to toes, single leg standing, compensatory stepping correction-forward/backward stepping, compensatory stepping correction- lateral, stance feet together with eyes open on firm surface, Stance feet together with eyes closed on foam surface, standing on incline with eyes closed, change in speed during gait, walking with horizontal head turns, walking with pivot turns, stepping over obstacles, timed up and go with dual task. MiniBest Test Scoring: It is a 14 item test that uses a 3 ordinal scale from (0-2). Rated 0 indicates severe impairment, 1 indicates moderate impairment and 2 indicates that the patient is normal. It addresses 4 of the 6 sections of the original Best Test. The Max score is 28 points, many researcher say 32pts because there needs to be calculation of both right and left sides in single leg standing and compensatory stepping correction, laterally. (6)
Pros and cons
Takes 10-15 minutes to administer
Excellent interrater reliability in patients with chronic stroke, balance impairments and Parkinson’s disease ICC = 0.98 (0.97-0.99)
No floor or ceiling effects that are seen in the berg balance test
Excellent Test-re test reliability 1-3 days post baseline assessment (6)
- The clinician will understand the test measures and which tools are appropriate to assess the patient
- The clinician will learn the benefits and/or downfalls of both balance tests
- The clinician will be able to identify which patients are most appropriate for both of the balance test.
- The clinician will learn about the evidence related to both of the balance assessments
Dynamic Gait Index Purpose (DGI): Assesses the patient’s ability to modify balance while walking in the presence of external demands.Dynamic Gait Index: Measures vestibular balance, non-vestibular balance, functional mobility and gait. It is performed with a marked distance of 20 feet and can be performed with or without an assistive device. The test requires a shoe box, two obstacles of the same size, stairs and a 20 foot pathway.
DGI Scoring: Scores are based on a 4- point scale. A score of 3 on a task indicatesno gait dysfunction, 2 indicates minimal impairment, 1 indicates moderate impairment and 0 indicated severe impairment. The highest score possible is 24 points.
< 19 indicative of increased fall risks (Sensitivity 59%, Specificity 64%)/(Sensitivity 67%, specificity 86%) In community dwelling older adults (4, 5)
DGI Task: Steady state walking, walking with changing speeds, walking with head turns both horizontally and vertically, walking while stepping over and around obstacles, pivoting while walking, and stair climbing. (1,7)
Pros and cons
- Takes less than 10 minutes to administer
- Excellent inter/intra-rater reliability in elderly adults in the hospital and outpatient setting
Hospital:- intrarater reliability (ICC = 0.90)
- interrater reliability (ICC = 0.92)
Outpatient Rehabilitation:- intrarater reliability (ICC = 0.89)
- interrater reliability (ICC = 0.82) (1,7)
- No Floor effect in generally healthy older adults
- Poor ceiling effect, 40% of healthy adults reach maximum score at baseline; 70% at maximum score after intervention. (3)
- There are adequate ceiling effects for multiple sclerosis and stroke patients and minimal floor effects for stroke patients. (1,7)
The Mini Best TestPurpose: Shortened version of the Balance Evaluation Systems Test (BESTest), a clinical balance assessment tool that aims to target and identify 6 different balance control systems.
The Mini Best Test: Measures 4 dimensions of balance including; anticipatory postural adjustments, reactive postural control, sensory orientation and dynamic gait. It allows the clinician to prepare treatments specific to the patients identified deficits. In order to perform this test the following is needed: Temper® foam (also called T-foamTM 4 inches thick, medium density T41 firmness rating), chair without arm rests or wheels, incline ramp, stopwatch, a box (9” height) and a 3 meter distance measured out and marked on the floor with tape [from chair].
Mini Best Test Task: Sit to stand, rise to toes, single leg standing, compensatory stepping correction-forward/backward stepping, compensatory stepping correction- lateral, stance feet together with eyes open on firm surface, Stance feet together with eyes closed on foam surface, standing on incline with eyes closed, change in speed during gait, walking with horizontal head turns, walking with pivot turns, stepping over obstacles, timed up and go with dual task.
MiniBest Test Scoring:
It is a 14 item test that uses a 3 ordinal scale from (0-2). Rated 0 indicates severe impairment, 1 indicates moderate impairment and 2 indicates that the patient is normal. It addresses 4 of the 6 sections of the original Best Test. The Max score is 28 points, many researcher say 32pts because there needs to be calculation of both right and left sides in single leg standing and compensatory stepping correction, laterally. (6)
Pros and cons
Resources
http://www.bestest.us
http://www.bestest.us/files/7413/6380/7277/MiniBEST_revised_final_3_8_13.pdf
https://www.health.qld.gov.au/pahospital/biru/docs/vestibular_gait.pdf
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=898
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1132
References
1. Cattaneo, D., Regola, A., et al. (2006). "Validity of six balance disorders scales in persons with multiple sclerosis." Disability and Rehabilitation 28(12): 789-795.
2. Wrisley, D. M., Walker, M. L., et al. (2003). "Reliability of the dynamic gait index in people with vestibular disorders." Arch Phys Med Rehabil 84(10): 1528-1533.
3. Shumway-Cook, A., Baldwin, M., et al. (1997). "Predicting the probability for falls in community-dwelling older adults." Physical Therapy 77(8): 812-819
4. Shumway-Cook, A., Gruber, W., et al. (1997). "The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults." Physical Therapy 77(1): 46-57.
5. Godi, M., Franchignoni, F., et al. (2013). "Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders." Phys Ther 93(2): 158-167
6. Cathy Harro MS PT, NCS (2010) “ Rehab measures: Mini Balance Evaluations System Test,” http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1132
7. Candy Tefertiller PT, DPT, ATP, NCS, Jennifer Kahn PT, DPT, NCS (2013) “Rehab measures: Dynamic Gait Index” http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=898